Healthcare Provider Details

I. General information

NPI: 1205716719
Provider Name (Legal Business Name): MRS. TASHA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W CENTURY BLVD STE 410-L
LOS ANGELES CA
90045-6401
US

IV. Provider business mailing address

7765 REBECCA RYAN CT
CORONA CA
92880-3220
US

V. Phone/Fax

Practice location:
  • Phone: 323-201-7085
  • Fax:
Mailing address:
  • Phone: 310-866-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: